Adrenaline for cardiac arrest
The quality of evidence is downgraded by study limitations (incomplete outcome data).
A Cochrane review 1 included 21 studies with a total of 21,704 subjects. The review provided moderate-quality evidence that standard-dose adrenaline compared to placebo improves return of spontaneous circulation, survival to hospital admission and survival to hospital discharge, but low-quality evidence that it did not affect survival with a favourable neurological outcome (table T1). Many of the studies were conducted more than 20 years ago.
Table 1. Standard-dose adrenaline (SDA) compared to placebo for out-of-hospital cardiac arrest.
|Outcome||Anticipated absolute effects* (95% CI)||Relative effect (95% CI)||Participants (studies)||Certainty of evidence (GRADE)|
|Risk with placebo||Risk with SDA|
|Survival to hospital discharge||23 per 1000||32 per 1000 (25 to 42)||RR 1.44 (1.11 to 1.86)||8538 (2)||Moderate (B)|
|Survival to hospital admission||83 per 1000||209 per 1000 (139 to 313)||RR 2.51 (1.67 to 3.76)||8489 (2)||Moderate (B)|
|Favourable neurological outcomes||19 per 1000||22 per 1000 (17 to 30)||RR 1.21 (0.90 to 1.62)||8535 (2)||Low (C)|
|*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio|
1. Finn J, Jacobs I, Williams TA et al. Adrenaline and vasopressin for cardiac arrest. Cochrane Database Syst Rev 2019;(1):CD003179. [PMID:30653257]
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